Chasing the scent of Love, Truth, Beauty, and Mirth, wherever it may lead.

Thursday, September 03, 2009

Is Health Care a Civil Right?A Community Conversation

Part 1Just the Facts

A series of town-hall meetings on health care reform convened in Hampton Roads, VA, this week, with 600 constituents estimated to have attended U.S. Rep. Rob Wittman’s Congressional District-1 event in Newport News on Aug. 31 and another 350 reported at Rep. Bobby Scott’s District-3 town hall, also in Newport News, on Sept. 1.

According to newspaper reports—and as might be expected—the majority view in Republican Wittman’s audience seemed to agree with him that no health-care reform at all would be better than HR-3200, the plan currently favored by most House Democrats and the Obama administration. But many if not most in Democrat Scott’s audience seemed willing to support him in backing HR-3200.

Missing from news reports of both meetings was any discussion of HR-676, the national, not-for-profit, single-payer health-care plan which will come to a vote on the floor of the House this fall in an amendment introduced by Rep. Anthony Weiner (D-NY). The Weiner Amendment calls for substituting the relatively straight-forward, 29-page HR-676 for the complex, 1,000-page HR-3200.

Scott was among 93 co-sponsors of HR-676 when it was introduced in the 110th Congress in 2007, but he did not sign on when it was reintroduced earlier this year in the current 111th Congress. He has stated, however, that he supports HR-676 but does not believe it can garner enough votes to pass. For that reason he supports HR-3200, which includes a “public option” that allows people to choose a Medicare-like, non-profit plan among the many private, for-profit insurance options also available.

Though neither Congressman’s meeting erupted into shouting and brawling, as seen elsewhere across the country on television news, in several instances partisan distrust, if not anger, did surface, threatening to derail rational discussion.

By contrast, in a gathering dignified by civility and restraint, a Community Conversation on Health Care which did highlight the single-payer option unfolded in the sultry late afternoon heat of August 30 at Norfolk’s Five Points Community Farm Market.

Maybe it was just too hot to fight. The block-long Farm Market building on Church St. between 26th and 25th Sts. operates without air conditioning, a throwback to several decades ago when products from local farms were similarly available to city shoppers. Despite the market’s two roaring water-cooled fans, the temperature in the building felt at least ninety degrees.

Or maybe it was because the event did not attract partisan opponents, no doubt a result of the discreet approach the self-described progressive organizers used to advertise the meeting, with invitations circulated through circles of friends and acquaintances by word of mouth, e-mail, texting, and announcements on Facebook and Twitter. In fact, detractors might argue with some merit that civility was achieved at the expense of a diversity of views, given that the event, though open to the public, was largely only known to those of relatively like mind.

In any case, no disruptive outbursts of anger or misinformation surfaced as three invited presenters—two physicians and a social activist/computer technology instructor—spoke in turn and took questions from the capacity audience of about eighty which filled the public meeting space at the south end of the Farm Market floor.

Dr. Keith Newby, head of Cardiology and Arrhythmia Associates in Norfolk, led off the presentations, probably pleasing his audience least for his rejection of health care as a right and his opposition to a national single-payer health-care system. More to the audience’s liking was Baltimore pediatrician Dr. Margaret Flowers' embrace of health care as a human right and her uncompromising call for the adoption of a single-payer system.

Supporting Dr. Flowers’ presentation with some leading details from HR-676 and HR-3200 was Andrea Miller, local coordinator for Progressive Democrats of America who may be best remembered for her unsuccessful run last year to unseat Republican Randy Forbes in the 4th Congressional District.

A fourth scheduled speaker, Charles Stanton, regional representative for Virginia U.S. Sen. Jim Webb, failed to appear. Jamal Gunn, field representative for Rep. Glenn Nye of Virginia’s 2nd Congressional district, showed up with no advance notice but, because of time constraints, was denied his request to speak from the podium.

Part 2A Conversation with My Doctor

About two weeks ago, taking advantage of a pause in proceedings while my primary-care doctor pored over my medical file during a routine visit, I asked the question I’d been anxious for some time to ask a medical professional.

“What do you think about health-care reform?”

My doctor, a stocky, blunt-talking Latin-American descendent with dark hair covering his bare forearms and sprouting from his open collar but shaved completely from his gleaming bald head, replied noncommittally but without hesitation.

“We need it,” he said.

I ventured a little further. “What do you think about single-payer?”

“We should have it,” he replied, not looking up as he leafed through the numerous pages of my file folder on the table in front of him.

“You support Medicare for all?” I asked him.

“Yes.”

I’d read that nearly sixty per cent of all doctors favor some form of a national health system. It pleased me to learn that my doctor was among them.

“I think Medicare is a pretty good system,” I said, speaking as a beneficiary myself.

“It is,” he said, still not looking up from the pages of my folder.

“Single-payer would make things easier for you, I guess.”

Then he looked up. “You cannot imagine what we go through,” he said, fixing me with his bespectacled, strangely peering, owl-like eyes.

“I know a little bit about it—all the differing forms you have to fill out for the different insurance companies.”

“That’s only a fraction of it,” he said. “You can’t imagine. You have no idea of all we have to do.”

“Like...what?” I wondered, holding my curiosity in check with effort.

As if responding to a shooting pain, my doctor gritted his teeth and gripped his bald head for a moment before releasing it. Was he having a stroke?

But then he said, “You’d have to be here to see what we have to go through. If I could do anything else, I would. I leave here at nine and ten o’clock every night, just dealing with all the paper work. I tell you, the insurance companies have too much power.”

“And the pharmaceutical companies?” I asked.

“Them, too.”

“But why are so many people against single-payer? Why doesn’t it have more support?”

That was the essence of our conversation, which left me feeling a bond of humanity with my doctor—a welcome positive—but also a sense of concern. It seemed to me that he is practicing medicine in a vortex of despair because the politics of health care are so heavily tilted away from relief—for himself as much as for his patients. By his own admission, my primary-care physician sees himself as little more than an indentured servant to the for-profit health care industry.

Part 3Conservative Reform

Though I’d never met Community Conversation speakers Dr. Margaret Flowers or Andrea Miller before, I know Dr. Keith Newby. He is the cardiologist who happened to be on the floor the afternoon of May 4, 2008, when I showed up at Norfolk’s DePaul Medical Center with symptoms of a heart attack. He saw me through three months of deteriorating health leading finally to surgery and then recovery. I’ve been his patient ever since.

Dr. Newby is a thorough, careful physician with a quick sense of humor and a sincere regard for the welfare of his patients. Yet in his health-care philosophy he favors a somewhat stern system of penalties and rewards. “In the end we all are responsible for our own health care,” he said. “If we do all we should do” to maintain good health—by which he seems to mean following doctor’s orders, themselves based upon peer-reviewed studies and proven practices—”we should be rewarded” by lower insurance premiums. “People who are doing good shouldn’t have to pay for those who are not.”

At the same time, “people need to know what to do. I’m a strong believer in prevention. There needs to be a concerted effort between Congress and the community to legislate strong preventive measures” as “an integral part” of health care reform.

Poor diet, lack of exercise, and smoking are the big three bad behaviors Dr. Newby singles out for the penalty of higher premiums.

“From a private practice perspective,” he said, “I believe everybody should have access to health care. But I don’t believe it’s necessarily a right.”

Clearly reform is needed, he believes, but favors a piecemeal reform—specific measures enacted to shore up and in a sense modernize the existing system. This includes tax reform. “Tax payers should be somewhat responsible for health care,” he said, including hospitals, all currently tax exempt, when their income exceeds a certain level.

Insurance companies need to be regulated to prevent refusal of coverage for pre-existing conditions or imposition of higher premiums for preventive measures such as dietary consultation. Tort reform is also on Dr. Newby’s list of necessary systemic tweaks, particularly to limit compensation for lawyers pressing medical malpractice suits.

He readily admits that “the cost of services is too high in a lot of circumstances. We have to come to the idea that all of us—practitioners, hospitals, and insurance companies—may have to take a reduction in pay.”

But by his own admission he is not fully informed on the plans being discussed in Washington. “On the Obama plan coming down,” he said, “I’m still learning.” And on single-payer, “I don’t favor it. I haven’t seen all the data, but from what I see I’m not a big total fan.”

Unfortunately, Dr. Newby—who, as I know, is a very busy man—did not linger to hear the substantive information presented by the other speakers on both single-payer and the majority-party alternatives Congress and the White House have been floating. If he had, it might, at the least, have expanded his data base.

Part 4Radical Reform

Dr. Margaret Flowers, who suspended her medical practice two years ago to devote herself to full-time advocacy for a national, single-payer health care system, is co-chair of the Maryland chapter of Physicians for a National Health Program and a dynamic, seemingly indefatigable champion of Medicare for all—”everybody in, nobody out.”

“Medicare,” she said, “is a beautiful system. Procedures must be approved, it’s true, but it covers what you need.”

Up to now leading Democrats, including the President, have dismissed single-payer as politically unfeasible, and, for whatever reason, the major media have largely ignored its existence. Yet polls have indicated that nearly seventy percent of Americans and sixty percent of doctors favor a single-payer system.

Single-payer activists, none more than Dr. Flowers, see the upcoming vote on the Weiner Amendment to replace HR-3200 ("America’s Affordable Health Choices Act of 2009") with HR-676 ("The Expanded and Improved Medicare for All Act") as their best opportunity yet to tilt the political scales their way. Accordingly, they have been out in full force, pushing an educational effort which the media has all but ignored. Their immediate aim is to mobilize that majority of grass-roots and professional support into an appeal to Congress, loud and clear, to pass the Weiner Amendment.

“Political feasibility is a fluid thing,” said Dr. Flowers. “If we don’t change the system, the suffering and unnecessary death (among the under- and uninsured) will go on. We need to change it. This is the civil rights movement of this decade, and we need to push for it.”

The American health-care system, she said, “is different from other industrial systems. What we have is an accident of history” by which health care became tied to insurance payments. “The insurance companies’ first responsibility is to make a profit for their investors. We are the only nation that allows this to exist.” As a result, “a lot of medical decisions are made by administrators without a medical background who tell doctors what they can and can’t cover.” In essence, the insurers are “practicing medicine without a license.”

Furthermore, thirty cents of every insurance dollar is spent on administrative costs, Dr. Flowers said. With Medicare, the ratio is three cents on the dollar. “The beauty of a single-payer system is it’s the only system that saves money.”

A single-payer system offers “universality (all are covered from birth), equity (you pay what you can afford), accountability (to the public), and free choice (of physicians and hospitals).” It would be supported by a universal payroll tax of about 4.5 percent—higher than present Medicare and Medicaid payroll taxes but far less than the “twenty to twenty-five percent of income now going for insurance.” Additionally, there would be no expensive co-pays.

“Even if they have insurance, people often put off health care because of expensive co-pays,” said Dr. Flowers. “Fifty-five percent of insured Americans do not fill prescriptions or see a doctor when they’re sick because of co-pays.”

“I left my medical practice,” she said, “because I could not provide quality care in the current system. Doctors have to see more and more patients to cover their overhead, to pay their staff. They’re not getting reimbursed for the time they need to spend with patients. They’re just trying to keep their practices alive.”

Meanwhile, she said, “The corporate strangle-hold in Congress is so tight. If we want real change it has to come from the grassroots. We’ve got to educate ourselves, our neighbors, and our families and contact our Congressional representatives. The understanding of health policy among those writing legislation is very low.”

Part 5Some Pros and Cons

“There are ten bills on health care now in Congress,” Andrea Miller said in her opening remarks as the final speaker in the community forum. She addressed herself to those most likely to come to a vote on the House floor in the near future—HR-3200 and HR-676.

Several features of HR-3200 are distinct improvements over the current dysfunctional system, she said. Among them, the bill “defines a minimum standard for health insurance” by enumerating “medically necessary procedures all qualified health plans must cover,” including “maternal and baby care. It puts mental health on parity with physical health. Pre-existing conditions may no longer be used as a reason for denying coverage. (Insurers) have to cover everybody.”

On the other hand, Miller continued, in HR-3200 “there is a mandate. You must buy it or the IRS will levy a fine on you. Every insurance company will be reporting to the IRS everyone it is covering.” Health care, then, is defined not as “a right but as a responsibility.”

HR-3200 will lower insurance premiums for basic coverage, said Miller, fixing them at no more than twelve percent of annual income. “But,” she added, “older Americans—a term left undefined—may be charged up to two times what a younger person is paying, a differential solely based on age.” And HR-3200 will likely add to administrative costs because of the additional expense of reporting to the IRS.

Other provisions Miller mentioned limit annual out-of-pocket medical expenses to $5,000 for an individual earning up to $43,320 annually and $10,000 for a family earning up to $88,200 while providing federal subsidies for insurance and co-pays for low-income individuals. Additionally, children but not adults are eligible for dental and vision coverage.

As for the public option, Miller said, it will require creation of a whole new infrastructure while offering premiums at private insurance rates.

“If you look at the money, and what we get,” she said, “this is a no-brainer.” Medicare for all, with its existing infrastructure, low administrative costs, and, under HR-676, its coverage of all essential medical care, including prescription drugs and dental, vision, and mental health services, is the most practical and efficient alternative to the present system.

It even provides transition funding for retraining and placement of private insurance-company administrators who will lose their jobs.

ConclusionWhy Wait?

On Sept. 2 Rep. Bobby Scott held a second town-hall meeting in the studios of WTKR-TV in Norfolk, where he addressed health care reform, largely in terms of HR-3200, and took questions from a respectful audience. In the course of the hour-and-a-half meeting—an hour of which was televised with the last half hour streamed live on WTKR’s website—Scott frankly admitted that HR-3200, with its public option for those not covered by an employer, is a start in the “right direction” toward a single-payer system. Given current political realities, it’s the best progressive Democrats in Congress feel they can do.

If he and other like-minded progressives are right, he said, over time the public option will become the preferred plan of a majority of Americans, opening the way down the road for a single-payer system.

If, on the other hand, they are wrong, the public option won’t attract enough customers to justify its inclusion in the system, and it will disappear.

Without a public plan, however—which, as Andrea Miller pointed out, insurance companies are spending $1.4 million a day in lobbying and advertising to defeat—Scott doubts any meaningful health-care reform is possible.

So while activists like Dr. Flowers and Andrea Miller fan the sparks of systemic dissent at the grass roots, hoping to ignite popular consciousness with a passion for substantive rather than superficial change, politicians like Bobby Scott, while sharing the vision, plot ways to force old-guard free-marketeers to accept transition by the inch rather than by the yard. Meanwhile, personal bankruptcies escalate, sixty-two percent of them, according to Dr. Flowers, due to medical debt, eighty percent of which befall individuals carrying private health insurance.

If we lived in a world where illness could be avoided, Dr. Newby’s punitive formula for those who become ill might make the most sense. But until proven otherwise, the Buddhist “remembrance” that we humans are of such nature that we cannot avoid getting sick seems to function as guiding wisdom. And since everyone gets sick at one time or another, why not all chip in the least so all can benefit the most?

Here in Virginia what I mostly hear from skeptics is they don't want the government interfering in their lives. That's what my doctor meant by "ignorant," I believe. All power to you in getting single-payer into PA!